2019 MEDICARE RATING

$0PLAN PREMIUM

CHOICES VALUE 2020 PEOPLES HEALTH CHOICES VALUE (HMO)

CHOICES GOLD 2020 PEOPLES HEALTH CHOICES GOLD (HMO-POS)

Lillie P. Peoples Health plan member

WELCOME Thank you for your interest in

Peoples Health. We’ve heard many times from our plan members that their health means everything to them. You probably feel the same way.

Whether you’re healthy and fit or you’ve got a complicated condition, Peoples Health wants you to enjoy the best health possible.

A good first step is understanding your options. We hope the information in this booklet will help you learn a little more about Medicare and give you a better understanding of Peoples Health as a way of receiving your Medicare coverage.

About our photographs... We would like to thank our plan members who gave of their time and of themselves for our photographs. They are the people of Peoples Health, and their health and vitality are inspirational.

On the cover: Marie M., Peoples Health plan member

What is Peoples Health? The choice of more than 75,000

Medicare beneficiaries in Louisiana. Founded in 1994 by medical providers and physicians, Peoples Health chose to focus on one thing: helping people with Medicare. That focus has helped Peoples Health become one of the largest Medicare Advantage organizations in Louisiana.*

For us, success is built on prevention and early detection. It’s built on easy access to care and face-to-face, personal attention. It’s built on providing free health education and fitness classes in the communities we serve. But the best measure of success is how much we can help our plan members reach their own health goals. We want you to be as healthy as you can be.

When we hear plan members like Nola W. saying, “I love Peoples Health. It changed my life,” we know we’re doing things right.

*CMS enrollment report by contract, plan, state and county, June 2019.

Harold P. Peoples Health plan member

Jane B. Peoples Health plan member

The ABCs (and D) of Medicare

A B C D

PART A is Hospital Insurance. It covers inpatient hospital services, skilled nursing facility care, hospice care and some home health services.

PART B is Medical Insurance. It covers doctor, outpatient hospital and preventive services, plus some home health and other services Part A does not cover.

PART C is Medicare Advantage. Medicare contracts with private insurers to administer Medicare benefits. Peoples Health offers Medicare Advantage plans that include Medicare Part D prescription drug coverage.

PART D is Outpatient Prescription Drug Coverage. This optional coverage is provided by private health insurance plans that contract with Medicare.

What is Medicare Advantage?

As good as Original Medicare is, it doesn’t cover everything.

With just Medicare, if you’re hospitalized — even for one day — you’ll face a $1,364 deductible.* For Part B services like doctor visits, there’s another deductible, and after that you’re generally responsible for 20 percent of the cost of those services.

If you want to add Part D prescription drug coverage, you have to join a Part D plan — usually with its own monthly premium.

Medicare Advantage plans (or Medicare Part C) can help reduce your costs. These plans generally offer more benefits than Original Medicare and often include Part D. Medicare Advantage plans are overseen by Medicare and are paid by Medicare to administer your benefits.

Nationwide, over 20 million people have chosen a Medicare Advantage plan for their Medicare coverage.∆

*Deductible listed is for 2019 and may change for 2020. ∆Henry J. Kaiser Family Foundation, “Medicare Advantage: A Fact Sheet,” June 6, 2019.

James B. Peoples Health plan member

Sherry M. Peoples Health plan member

Rewards Incentives for taking care

of your health. We want you to be as healthy as you can be. Since we know that may take a bit of effort, we’ll reward you for certain healthy activities.

For example, we ask our plan members to meet with a nurse practitioner to review their current health, their history, and their health goals. The official name for the visit is a Comprehensive Wellness Assessment. Its purpose is simple: to promote prevention and early detection and to provide valuable information to your primary care doctor.

If you are a Peoples Health plan member, you can earn a gift card from us for retailers such as CVS Pharmacy, Shell, Walmart, or others — just for getting that wellness assessment. It’s just one of the ways we try to help you enjoy the best health possible.

The Measure of Quality

Peoples Health: 4.5 out of 5 stars for 2019. Highest rated plans in Louisiana.

It may be easy to compare plans based on costs and copayments, but Medicare also offers a measure of quality. It’s their star rating.

Medicare developed its star rating system to give people with Medicare an objective measure of a plan’s performance. The rating system gives people a way to consider quality as well as cost as they make their enrollment decisions. Medicare evaluates plans every year and scores them on a scale of 1 to 5 stars, with 5 stars indicating the highest performance.

Medicare started rating Medicare Advantage plans in 2008, and Peoples Health has always scored high. For the last four years, we earned a rating of 4 stars or higher out of 5. In 2019, only 1 in 5 plans nationwide earned 4.5 stars or higher. In Louisiana, only Peoples Health reached 4.5 stars — the highest quality rating in the state.

William M. Peoples Health plan member

Ronald L. Peoples Health plan member

You Have Choices! Choose more money in your Social Security check

or lower copays and more services.

At Peoples Health, we want you to enjoy the best health possible – and the best plan for your needs. If you want more money in your Social Security check every month,

our Choices Value plan may be what you’re looking for. If you want lower copays and more services than Choices Value, our Choices Gold plan may be right for you.

NEW: Peoples Health Choices Value Get a $40 Part B premium Give Back every month for the year 2020. What’s a Give Back? We pay $40 per month of your Part B premium.* That’s $480 over the course of the year. And you can use that money any way you want!

Choices Value members enjoy: • $0 plan premium • All the benefits of Medicare • $40 Give Back each month • $0 fitness center membership • $0 preventive dental coverage • Part D drug coverage • And more!

Peoples Health Choices Gold Get lower out-of-pocket costs, more benefits and out-of-network coverage.

Choices Gold members enjoy: • $0 plan premium • All the benefits of Medicare • $0 over-the-counter medications and health

and wellness products — $40 allowance per calendar quarter

• $0 fitness center membership • $0 Meals after hospital stays • $0 eyeglasses or contact lenses • $0 hearing aids – up to $1,000 in coverage • Preventive and comprehensive dental

coverage • Respite care for members with dementia • Part D drug coverage • And more!

*The Give Back is administered through the Social Security Administration, and depending on how you pay your Part B premium, it will show as an increase in your monthly Social Security check or a credit on your Part B statement.

Peoples Health Choices Gold (HMO-POS)Peoples Health Choices Value (HMO)

$0 Monthly Plan

Premium

Part B Premium Give Back & Network Value Gold

Monthly Part B Premium Give Back $40 $0 Worldwide Emergency and Urgent Carev Value Gold

Emergency Care – Copay waived if admitted $90 $90Out-of-Network Coverage 8 4*

Doctor Visits Urgently Needed Care $50 $40 Emergency Transportation per one-way trip Primary Care Physician Visit $20 $0

Virtual Visit $0 $0 Emergency Ambulance Services (ground or air) $235 $260 Specialist Visit $50 $40 Home Health

Preventive Care+ Home Health Care $0 $0 Pap Smears, Pelvic Exams, Mammograms $0 $0 Skilled Nursing Facility Care Prostate and Colorectal Cancer Screenings $0 $0 Semiprivate Room and Board $0 $0(per day for days 1-20) Bone Mass Measurement $0 $0 Vaccinations (flu, pneumonia, hepatitis B) $0 $0

Labs and Tests∆+

Semiprivate Room and Board (per day for days 21-100) $165 $165

Outpatient Services and Supplies Lab Services $20 $0 Diagnostic Tests, X-rays $20 $10 Advanced Imaging (MRI, MRA, CT, CTA, etc.) $130 $120

Outpatient Surgery Ambulatory Surgical Center or Outpatient Hospital Outpatient Surgery $350 $250

Inpatient Hospital Care per admission Inpatient Deductible $0 $0

Hospital Stay per day $350 (days 1-5)

$195 (days 1-10)

Occupational, Physical or Speech $40 $20Therapy Visit

Durable Medical Equipment (DME) 20% 20% (wheelchairs, oxygen, etc.) coinsurance coinsurance

Diabetes Monitoring Supplies (test strips, $0 $0monitor, etc., from a preferred DME provider)

Mental Health and Substance Abuse Treatment

$350 $195Inpatient Mental Health Care (days 1-5) (days 1-9)

Inpatient Mental Health Care $0 $0(days 6-90 for Value, 10-90 for Gold) Hospital Stay Substance Abuse Specialist Office Visit or$0 $0 $40 $40(beyond day 5 for Value or day 11 for Gold) Outpatient Mental Health Visit

Additional Benefits not covered by Original Medicare

Meals After Hospital Stays (up to two meals per day 8 $0for five days after an inpatient hospital stay) Tier 1 $0 $0 $0 $0

Vision Services

Routine Eye Exam $0 $35

Medicare Part D Prescription Drug Coverage

Choices Value Choices Gold

30-Day Supply

90-Day Supply

30-Day Supply

90-Day Supply

Tier 2 $10 $0

preferred mail order

$10 $0

preferred mail order

Tier 4 $100 $300 $100 $300

Over-the-Counter Health and Wellness Items Value Gold

$40 allowance (every quarter by mail order) 8 $0 Meals

Eyeglasses or Contact Lenses (one pair per year) 8 $0 Hearing Aid Services≈

Hearing Aid Exam for Evaluation and Fitting 8 $0 Hearing Aids (up to one per ear, max of $1,000 for both) 8

Tier 3 $45 $135 $45 $135

$0

Dental

27% 33%Tier 5 coinsurance coinsurance

Tier 1 and 2 generics COVERED through the Coverage Gap Choices Value has a $300 deducible on Tiers 4 and 5.

Oral Exams and Cleanings (every six months) $0 $0 X-rays (one set per year) $0 Comprehensive Dental (such as fillings and dentures,

8$50 deductible applies; up to $1,250 in coverage)

Respite Care for members with Alzheimer’s or dementia

Up to 12 respite care sessions per year 8(each session can be up to four hours)

Fitness

Health Club Membership $0

$0 Copays

vary

$0

$0

+Ofce visit copay may apply. ‡Part B Premium Give Back is the amount of your Medicare Part B premium paid by Peoples Health. *Costs listed are for in-network services. Out-of-network coverage has a $1,500 deductible and is available for many services, in most cases at 30% coinsurance. Some limitations and restrictions may apply. ∆Lab services, diagnostic tests and X-ray costs may vary based on location of service. ≈Hearing aid services through the TruHearing network. vEmergency care copay waived if admitted to inpatient hospital care within 24 hours for the same condition. Up to $5,000 of coverage for emergency and urgently needed care (combined) outside the U.S. and its territories.

Peoples Health Choices Gold and Choices Value

are available in the

following parishes:

✓✓Acadia

✓✓Bossier ✓✓Lafayette ✓✓Caddo ✓✓Ouachita

✓✓Calcasieu ✓✓St. Landry

✓✓Cameron ✓✓St. Martin

✓✓Evangeline ✓✓Vermilion

✓✓Iberia

If you live in a different parish, call to see what Peoples Health plans are available in your area.

If you have Medicare and get medical assistance from the state—such as paying your Part B premium—ask about a Peoples Health special needs plan. You may

be entitled to additional coverage and savings.

Compare your Medicare coverage to a Peoples Health

Medicare Advantage plan.

Ready to enroll? Here are three easy ways

to enroll today:

Call toll-free 1-800-536-3570 (TTY: 711)

Visit us online at www.peopleshealth.com

Book an in-home appointment

For more information on Medicare or our plan benefits, call toll-free:

1-800-536-3570 (TTY: 711) 8 a.m. to 8 p.m.

Seven days a week from October 1 through December 7 Monday through Friday from December 8 through September 30

Asistencia disponible en español.

Three Lakeway Center | 3838 N. Causeway Blvd., Suite 2200 | Metairie, LA 70002 | www.peopleshealth.com

Connect with us.

This plan overview is for Peoples Health plan H1961-017 and Peoples Health plan H1961-018. Peoples Health is a Medicare Advantage organization with a Medicare contract to ofer HMO plans. Enrollment depends on annual Medicare contract renewal. Every year, Medicare evaluates plans based on a 5-star rating system. Peoples Health is rated 4.5 out of 5 stars for 2019. The “highest-rated” designation is based on the Medicare star ratings for Medicare Advantage and Special Needs Plans listed in the CMS publication “Medicare & You 2019.” H1961_PH20CGCVOVB_M